Buying Part A when you don't have 40 quarters

The short version

The spouse rules nobody mentions

You may qualify for premium-free Part A through:

• A current spouse with 40 quarters, if married at least 1 year and your spouse is at least 62
• An ex-spouse with 40 quarters, if married at least 10 years and currently unmarried
• A deceased spouse with 40 quarters, if married at least 9 months before their death

Check your eligibility through Social Security before paying. We've seen people pay Part A premiums for years before learning they qualified through a former spouse.

Buying Part A: the price scales

If you don't qualify through work history, you can still buy Part A:

• 30–39 quarters: reduced monthly premium (typically a few hundred dollars)
• Fewer than 30 quarters: full Part A premium (typically over $500/month)

If you buy Part A, you must also enroll in Part B and pay that premium too. You can't take Part A on its own.

Lawful permanent residents

If you're a lawful permanent resident (green card holder) age 65+ who hasn't worked enough in the U.S., you can buy Parts A and B after 5 continuous years of U.S. residence as a lawful permanent resident. You can also qualify through a spouse on the same rules above.

When buying Part A makes sense

• You can't qualify through a spouse and don't want to risk being uninsured
• You're not eligible for a Marketplace plan or your Marketplace plan is more expensive than Part A + Part B
• You qualify for a Medicare Savings Program (QMB pays Part A and B premiums)
• You can't get HSA-eligible coverage and the math otherwise works

When it usually doesn't

• You can earn the remaining quarters working a few more years
• You're under 65 and qualify for Marketplace subsidies based on low income
• A spouse will qualify you for premium-free Part A in the near future

Frequently asked questions

Who has to pay for Part A?

About 1% of beneficiaries — people without enough work credits and without a spouse who earned 40 quarters of Medicare-taxed work. If you have 30–39 quarters, the premium is lower. With fewer than 30, you pay the full Part A premium.

Can my spouse's work history qualify me for premium-free Part A?

Yes, if you've been married at least one year (current spouse), or if you're divorced after at least 10 years of marriage, or widowed. Your spouse or ex-spouse must have 40 quarters of Medicare-taxed work.

Can I qualify for premium-free Part A through a deceased spouse?

Yes. A surviving spouse age 65 or older qualifies based on the deceased spouse's work record, as long as the marriage lasted at least 9 months before the death (with some exceptions for accidental death and military service).

What if I'm a legal U.S. resident but didn't work here long enough?

You may still buy Part A and B if you've lived in the U.S. continuously for at least 5 years as a lawful permanent resident. The Part A premium scales with how many quarters you have. Some legal residents also qualify through a spouse.

Should I buy Part A if I can get it free another way?

Almost never. If you're close to 40 quarters, working a few more quarters under Social Security can be cheaper than paying years of Part A premiums. Some people also qualify through a spouse without realizing it.